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NPI Code Detail

MEDICARE: DR. ALICIA MICHELLE HARRISON-SICRE O.D.

MEDICARE: DR. ALICIA MICHELLE HARRISON-SICRE O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPT11495TPLCA
2152W00000XOptometrist11495TLGCA

General Provider Information

NPI Number : 1124247523
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALICIA MICHELLE HARRISON-SICRE O.D.
Provider Business Mailing Address
First Line : 1100 S COAST HWY
Second Line : STE 201
City : LAGUNA BEACH
State : CA
Zip : 92651-2968
Country : US
Telephone Number : 949-497-1769
Fax Number : 949-497-2808
Provider Business Practice Location Address
First Line : 1100 S COAST HWY
Second Line : STE 201
City : LAGUNA BEACH
State : CA
Zip : 92651-2968
Country : US
Telephone Number : 949-497-1769
Fax Number : 949-497-2808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 06/10/2019

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